HomeMy WebLinkAbout4132 STONERIDGE CT - APPLICATIONS - 10/13/2014Planning, Development & Transportation
City of I p 281 N. College Ave P.O. Box 580
Fort Collins 1s Fort Collins, CO 80524
�- Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # `� r% �� 5 Date
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
y 13 Z 5-To IqG R t D &-G
CT
1 31 9 8 7. 76
Property Owner Name
Address
City/State
Zip
Phone
'y`IFl IN E6EIZI
11132 STWCRIDC Cc-F PC C6
60S7'S
Applicant Name
Address
City/State
Zip
Phone
5Co-1, ZIc`C
3226tAcspveeo
Fc (o
�0525
Zly-4�11
Contractor
Address
City/State
Zip
Phone
Z,c,I.L C.6F(5T-9vM6N
1\
It
Contractor City of Ft. Collins Sales Tax
#
Sales tax number is required by all contractors.
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or corp�mercial project? Ltt Residential ❑ Commercial
If residential, is it: ErSiingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to t975, you will need an asbestos assessment to submit with this application.
Description of work T EB (Z OEF I Ca M P -Sy' 1 f`l"6 . I LA 5 cI
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber Mechanical Roofer J(k 00it-lJ Other
I hereby acknowledge that I have read this application and state that the above Information is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and state laws regulati g building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant:
Print Name: 5(0-h Z 1 C. V— Signature Date